| NPI | 1184757700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN9172) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA 9535) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2023-01-05 |